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Elmunzer BJ, Anderson MA, Mishra G, Rex DK, Yadlapati R, Shaheen NJ. Quality indicators common to all GI endoscopic procedures. Gastrointest Endosc 2024; 100:382-394. [PMID: 38935015 DOI: 10.1016/j.gie.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 06/28/2024]
Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle A Anderson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Girish Mishra
- Section of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rena Yadlapati
- Division of Gastroenterology & Digestive Health, University of California San Diego, San Diego, California, USA
| | - Nicholas J Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Elmunzer BJ, Anderson MA, Mishra G, Rex DK, Yadlapati R, Shaheen NJ. Quality Indicators Common to All Gastrointestinal Endoscopic Procedures. Am J Gastroenterol 2024:00000434-990000000-01295. [PMID: 39167096 DOI: 10.14309/ajg.0000000000002988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 08/23/2024]
Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michelle A Anderson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Girish Mishra
- Section of Gastroenterology and Hepatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rena Yadlapati
- Division of Gastroenterology & Digestive Health, University of California San Diego, San Diego, California, USA
| | - Nicholas J Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Zhao Z, Jin X, Li Y, Wang X, Cui Y, Zhang B, Kang Y, Zhang G, Chu Q, Zhang J. Efficacy and safety of fospropofol disodium sedation for same-day bidirectional endoscopy in elderly patients: protocol for a prospective, single-center, randomized, double-blind, non-inferiority trial. Front Pharmacol 2024; 15:1378081. [PMID: 39175547 PMCID: PMC11338772 DOI: 10.3389/fphar.2024.1378081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/26/2024] [Indexed: 08/24/2024] Open
Abstract
Introduction Fospropofol disodium is a novel prodrug that has improved pharmacokinetic and pharmacodynamic properties when compared with propofol. This trial aims to compare the efficacy and safety of fospropofol versus propofol sedation for same-day bidirectional endoscopy in elderly patients. Methods and analysis This is a prospective, single-center, double-blind, randomized, propofol-controlled, non-inferiority trial. A total of 256 patients aged 65 years or older, who are scheduled for same-day bidirectional endoscopy under sedation, will be randomly allocated, in a 1:1 ratio, to either fospropofol group or propofol group (n = 128 in each group). All patients will receive analgesic pre-treatment with sufentanil 5 μg. Two minutes later, an initial bolus dose of fospropofol 6.5 mg/kg or 1.5 mg/kg propofol and supplemental doses of fospropofol 1.6 mg/kg or 0.5 mg/kg propofol will be titrated as needed to achieve target sedation levels during the procedures. The primary outcome is the success rate of same-day bidirectional endoscopy. Secondary outcomes include the time to successful induction of sedation, duration, time to being fully alert, time to patient discharge, endoscopist satisfaction, patient satisfaction, and the top-up frequency and dosage of sedative medications. The safety endpoints consist of adverse events concerning cough reflex, gag reflexes, body movement, muscular tremor, and pain on injection. Sedation-related AEs, including episodes of desaturation, severe desaturation (SpO2 < 90%), hypotension, severe hypotension (decrease in MBP ≥30% of baseline), and bradycardia, will also be recorded. Data will be analyzed on an intention-to-treat basis. Discussion We hypothesize that the efficacy and safety of fospropofol sedation for elderly patients undergoing same-visit bidirectional endoscopy will not be inferior to that of propofol. Our findings will potentially provide a new sedation regimen for same-visit bidirectional endoscopy in elderly patients. Clinical Trial Registration clinicaltrials.gov, identifier NCT02875639.
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Affiliation(s)
- Zhe Zhao
- Department of Geriatrics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaogao Jin
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yong Li
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Wang
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongchen Cui
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Zhang
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Kang
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangming Zhang
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinjun Chu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Moriwake K, Isozaki H, Takama T, Murakami S, Matsumoto S. A case report of splenic injury related to colonoscopy: Fortunately treated with conservative treatment. DEN OPEN 2024; 4:e287. [PMID: 37663227 PMCID: PMC10474310 DOI: 10.1002/deo2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
Colonoscopy is a common procedure for screening of colon cancer. Although complications are rare, recently there have been reports of splenic injury associated with colonoscopy. Its causes are not clear. Herein, we report an 84-year-old man who underwent a colonoscopy for an annual routine examination. The colonoscopy was performed with moderate difficulty due to loop formation and took about 50 min. After the examination, he developed syncope, sweating, and abdominal distention with low blood pressure. Plain computed tomography revealed ascites, and the patient was hospitalized with close monitoring. The following day, his hemoglobin level was decreased by about 3.0 g/dL. Contrast-enhanced computed tomography revealed the splenic injury. The patient was hemodynamically stable and was treated conservatively. Splenic injury is an uncommon complication of colonoscopy; however, it may cause hemodynamic instability. Physicians performing colonoscopies should be aware of this potential complication.
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Emara MH, Mazid U, Elshaer YA, Elkerdawy MA, Malik DF, Mahros AM. Trauma to the solid abdominal organs: The missed dark box of colonoscopy. World J Gastroenterol 2024; 30:624-630. [PMID: 38515946 PMCID: PMC10950622 DOI: 10.3748/wjg.v30.i7.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Colonoscopy is an integral part of the lower bowel care and is generally considered a potentially safe diagnostic and therapeutic procedure performed as a daycare outpatient procedure. Colonoscopy is associated with different complications that are not limited to adverse events related to the bowel preparation solutions used, the sedatives used, but to the procedure related as well including bleeding and perforation. Injuries to the extra-luminal abdominal organs during colonoscopy are uncommon, however, serious complications related to the procedure have been reported infrequently in the literature. Life threatening injuries to the spleen, liver, pancreas, mesentery, and urinary bladder have been reported as early as in mid-1970s. These injuries should not be overlooked by clinicians and endoscopists. Steadily increasing abdominal pain, abdominal distension, and hemodynamic instability in absence of rectal bleeding should raise the possibility of severe organ injury. Splenic and hepatic injury following colonoscopy are usually serious and may be life threatening. Although conservative management may help, yet they usually need interventional radiology or surgical intervention. Acute pancreatitis following colonoscopy is usually mild and is mostly managed conservatively. The mechanism of abdominal organ injuries during colonoscopy is not fully understood, however many risk factors have been identified, which can be classified as- organ related, procedure related, and local abdominal factors. Difficult colonoscopy and prior intra-abdominal adhesions are probably the most relevant risk factors for these injuries. Left lateral position, avoidance of looping and excessive force during the procedure would probably reduce the risk of such injuries.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Usama Mazid
- Department of Medicine, Alyousif Hospital, Alkhobar 31952, Saudi Arabia
| | - Yasmine A Elshaer
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mahmoud A Elkerdawy
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | | | - Aya M Mahros
- Department of Hepatology, Gastroenterology, and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
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Soheilipour M, Tabesh E, Afsharzadeh M, Tabibian A. Rectus abdominis muscle abscess after performing colonoscopy-A case report. Clin Case Rep 2024; 12:e8552. [PMID: 38415191 PMCID: PMC10896747 DOI: 10.1002/ccr3.8552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/05/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
Endoscopic removal of premalignant polyps can prevent colorectal cancers. It is considered a safe procedure, yet there are some complications reported. Rectus abdominis muscle abscess (RAMA) is a type of pyomyositis seen as a complication of rectus sheath hematoma. Predisposing factors to RAMA include trauma, diabetes mellitus, alcohol abuse, Intravenous drug abuse and hematologic diseases.In this article, we report a case of a 74-year-old patient with abscess formation in the Rectus Abdominis muscle after colonoscopy and polypectomy with the application of abdominal pressure techniques without any early complications. Diagnosis of RAMA was made after a Computed Tomography scan and ultrasound-guided drainage, in addition to antibiotic therapy, were used as treatment.Although colonoscopy is considered a generally safe procedure, endoscopists should be aware of Rectus Abdominis sheath hemorrhage and RAMA in the following as a complication with the presentation of abdominal pain. Applying abdominal pressure should be done carefully To reduce minor trauma likelihood, owing to it being a predisposing factor of RAMA.
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Affiliation(s)
- Maryam Soheilipour
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
| | - Elham Tabesh
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
| | | | - Amirhossein Tabibian
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
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Lukies M, Clements W. Splenic artery embolisation for splenic injury during colonoscopy: A systematic review. United European Gastroenterol J 2024; 12:44-55. [PMID: 38047383 PMCID: PMC10859723 DOI: 10.1002/ueg2.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Splenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low-grade injuries or with splenectomy for high-grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation. METHODS A systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality. RESULTS The 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59-70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81). CONCLUSIONS Splenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.
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Affiliation(s)
- Matthew Lukies
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
| | - Warren Clements
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
- National Trauma Research InstituteMelbourneVictoriaAustralia
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Alexandersson BT, Andreasson A, Hedin C, Broms G, Schmidt PT, Forsberg A. Inflammatory Bowel Disease Is not Linked to a Higher Rate of Adverse Events in Colonoscopy-a Nationwide Population-based Study in Sweden. J Crohns Colitis 2023; 17:1962-1967. [PMID: 37402690 PMCID: PMC10798860 DOI: 10.1093/ecco-jcc/jjad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease may cause long-standing inflammation and fibrosis and may increase the risk of adverse events in colonoscopy. We evaluated whether inflammatory bowel disease and other potential risk factors are associated with bleeding or perforation in a nationwide, population-based, Swedish study. METHODS Data from 969 532 colonoscopies, including 164 012 [17%] on inflammatory bowel disease patients, between 2003 and 2019, were retrieved from the National Patient Registers. ICD-10 codes for bleeding [T810] and perforation [T812] within 30 days of the colonoscopy were recorded. Multivariable logistic regression was used to test if inflammatory bowel disease status, inpatient setting, time period, general anaesthesia, age, sex, endoscopic procedures, and antithrombotic treatment were associated with higher odds for bleeding and perforation. RESULTS Bleeding and perforation were reported in 0.19% and 0.11% of all colonoscopies, respectively. Bleeding [odds ratio 0.66, p <0.001] and perforation [odds ratio 0.79, p <0.033] were less likely in colonoscopies in individuals with inflammatory bowel disease status. Bleeding and perforation were more common in inpatient than in outpatient inflammatory bowel disease colonoscopies. The odds for bleeding but not perforation increased between 2003 to 2019. General anaesthesia was associated with double the odds for perforation. CONCLUSIONS Individuals with inflammatory bowel disease did not have more adverse events compared with individuals without inflammatory bowel disease status. However, the inpatient setting was associated with more adverse events, particularly in inflammatory bowel disease status. General anaesthesia was associated with a greater risk of perforation.
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Affiliation(s)
| | - Anna Andreasson
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
- School of Psychological Sciences Macquarie University, North Ryde, NSW 2109, Australia
| | - Charlotte Hedin
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
- Karolinska University Hospital, Department of Gastroenterology, Dermatovenerology and Rheumatology, Stockholm, Sweden
| | - Gabriella Broms
- Gastroenterology, Danderyd hospital, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Peter T Schmidt
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Forsberg
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Kolla E, Weill A, Desplas D, Semenzato L, Zureik M, Grimaldi L. Does Measles, Mumps, and Rubella (MMR) Vaccination Protect against COVID-19 Outcomes: A Nationwide Cohort Study. Vaccines (Basel) 2022; 10:1938. [PMID: 36423033 PMCID: PMC9694832 DOI: 10.3390/vaccines10111938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 10/10/2023] Open
Abstract
Cross-protection from previous live attenuated vaccines is proposed to explain the low impact of COVID-19 on children. This study aimed to evaluate the effect of live attenuated MMR vaccines on the risk of being hospitalized for COVID-19 in children. An exposed (MMR vaccine)-non-exposed cohort study was conducted using the nationwide French National Health Data System (SNDS). We included children born between 1 January 2009 and 31 December 2019. Exposure was defined as a claim of at least one dose of MMR vaccine since birth. Hospitalization for COVID-19 was defined using main diagnostic ICD10 codes. Non-conditional logistic regression was used to calculate the adjusted odds ratios (aORs) of the association between MMR exposure and hospitalization for COVID-19, controlling for socio-demographic and socio-economic factors, co-morbidities, and general health. In total, 6,800,542 (median age 6 IQR [3-8] years) children exposed to a MMR vaccine and 384,162 (6 [3-9] years) not exposed were followed up with for 18 months. Among them, 873 exposed to the MMR vaccine and 38 who were not exposed were hospitalized for COVID-19. In a multi-variate analysis, the exposure of children to MMR vaccination was not associated with a decreased risk of COVID-19 hospitalization versus non-exposure (aOR (95%CI) = 1.09 [0.81-1.48]). A stratified analysis by age showed an aOR = 1.03 [0.64-1.66] for children aged 1-4, an aOR = 1.38 [0.82-2.31] for those aged 5-9, and an aOR = 1.11 [0.54-2.29] for those aged 10-12. Our study suggests that the live attenuated MMR vaccine does not protect children against COVID-19 hospitalization.
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Affiliation(s)
- Epiphane Kolla
- EPI-PHARE (Scientific Interest Group in Epidemiology of Health Products), French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, CEDEX, 93285 Saint-Denis, France
- INSERM (National Institute of Health and Medical Research), University of Paris-Saclay, University Versailles Saint Quentin, Anti-Infective Evasion and Pharmacoepidemiology Team, 78180 Montigny-Le-Bretonneux, France
| | - Alain Weill
- EPI-PHARE (Scientific Interest Group in Epidemiology of Health Products), French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, CEDEX, 93285 Saint-Denis, France
| | - David Desplas
- EPI-PHARE (Scientific Interest Group in Epidemiology of Health Products), French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, CEDEX, 93285 Saint-Denis, France
| | - Laura Semenzato
- EPI-PHARE (Scientific Interest Group in Epidemiology of Health Products), French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, CEDEX, 93285 Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE (Scientific Interest Group in Epidemiology of Health Products), French National Agency for the Safety of Medicines and Health Products, French National Health Insurance, CEDEX, 93285 Saint-Denis, France
- INSERM (National Institute of Health and Medical Research), University of Paris-Saclay, University Versailles Saint Quentin, Anti-Infective Evasion and Pharmacoepidemiology Team, 78180 Montigny-Le-Bretonneux, France
| | - Lamiae Grimaldi
- Clinical Research Unit AP-HP, Paris-Saclay, Hôpital Raymond Poincare, School of Medicine Simone Veil, University Versailles Saint Quentin—University Paris Saclay, INSERM (National Institute of Health and Medical Research), CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, 78180 Montigny-Le-Bretonneux, France
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Zessner-Spitzenberg J, Waldmann E, Ferlitsch M. [Quality Assurance of Screening Colonoscopy in Austria and Europe]. JOURNAL FUR GASTROENTEROLOGISCHE UND HEPATOLOGISCHE ERKRANKUNGEN 2022; 20:103-112. [PMID: 36320614 PMCID: PMC9610308 DOI: 10.1007/s41971-022-00137-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/05/2022]
Abstract
Die Vorsorgekoloskopie als effizientes Tool zur Reduktion von Kolorektalkarzinominzidenz und -mortalität ist nur dann effektiv, wenn sie unter hohen Qualitätsstandards durchgeführt wurde. Die European Society for Gastrointestinal Endoscopy gibt hierbei Key Performance Measures, wie die Adenomentdeckungsrate, die Zökumerreichsrate und die Rate an adäquater Vorbereitungsqualität, vor, auf die beim Screening geachtet werden sollten. Das „Qualitätszertifikat Darmkrebsvorsorge“, das als Qualitätssicherungsprogramm auf freiwilliger Basis von der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie gemeinsam mit dem Dachverband der österreichischen Sozialversicherungsträger und der Österreichischen Krebshilfe für Endoskopiker:innen in ganz Österreich ins Leben gerufen wurde, überprüft diese Qualitätsparameter. Es wird ein Darmkrebsscreening auf höchsten Standards angestrebt, um somit die besten Outcomes für Patient:innen zu erzielen. Auch europaweit ist das Interesse an einer qualitätsgesicherten Vorsorgekoloskopie groß: Viele Länder, wie z. B. die Niederlande, Norwegen und das Vereinigte Königreich haben Programme, um die Qualität des Screenings zu überwachen und zu verbessern.
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Affiliation(s)
- Jasmin Zessner-Spitzenberg
- Klinische Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 7i, 1090 Wien, Österreich
- Arbeitsgruppe Qualitätssicherung, Österreichische Gesellschaft für Gastroenterologie und Hepatologie, Wien, Österreich
| | - Elisabeth Waldmann
- Klinische Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 7i, 1090 Wien, Österreich
- Arbeitsgruppe Qualitätssicherung, Österreichische Gesellschaft für Gastroenterologie und Hepatologie, Wien, Österreich
| | - Monika Ferlitsch
- Klinische Abteilung für Gastroenterologie und Hepatologie, Univ. Klinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 7i, 1090 Wien, Österreich
- Arbeitsgruppe Qualitätssicherung, Österreichische Gesellschaft für Gastroenterologie und Hepatologie, Wien, Österreich
- Abteilung für Innere Medizin II, Gastroenterologie und Hepatologie, Evangelisches Krankenhaus Wien, Wien, Österreich
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Kobe EA, Sullivan BA, Qin X, Redding TS, Hauser ER, Madison AN, Miller C, Efird JT, Gellad ZF, Weiss D, Sims KJ, Williams CD, Lieberman DA, Provenzale D. Longitudinal assessment of colonoscopy adverse events in the prospective Cooperative Studies Program no. 380 colorectal cancer screening and surveillance cohort. Gastrointest Endosc 2022; 96:553-562.e3. [PMID: 35533738 PMCID: PMC9531542 DOI: 10.1016/j.gie.2022.04.1343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/30/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Data are limited regarding colonoscopy risk during long-term, programmatic colorectal cancer screening and follow-up. We aimed to describe adverse events during follow-up in a colonoscopy screening program after the baseline examination and examine factors associated with increased risk. METHODS Cooperative Studies Program no. 380 includes 3121 asymptomatic veterans aged 50 to 75 years who underwent screening colonoscopy between 1994 and 1997. Periprocedure adverse events requiring significant intervention were defined as major events (other events were minor) and were tracked during follow-up for at least 10 years. Multivariable odds ratios (ORs) were calculated for factors associated with risk of follow-up adverse events. RESULTS Of 3727 follow-up examinations in 1983 participants, adverse events occurred in 105 examinations (2.8%) in 93 individuals, including 22 major and 87 minor events (examinations may have had >1 event). Incidence of major events (per 1000 examinations) remained relatively stable over time, with 6.1 events at examination 2, 4.8 at examination 3, and 7.2 at examination 4. Examinations with major events included 1 perforation, 3 GI bleeds requiring intervention, and 17 cardiopulmonary events. History of prior colonoscopic adverse events was associated with increased risk of events (major or minor) during follow-up (OR, 2.7; 95% confidence interval, 1.6-4.6). CONCLUSIONS Long-term programmatic screening and surveillance was safe, as major events were rare during follow-up. However, serious cardiopulmonary events were the most common major events. These results highlight the need for detailed assessments of comorbid conditions during routine clinical practice, which could help inform individual decisions regarding the utility of ongoing colonoscopy follow-up.
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Affiliation(s)
- Elizabeth A Kobe
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; School of Medicine, Duke University, Durham, NC
| | - Brian A Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Cameron Miller
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jimmy T Efird
- Cooperative Studies Program Coordinating Center, Boston VA Health Care System, Boston, MA
| | - Ziad F Gellad
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC
| | - David A Lieberman
- Portland Veteran Affairs Medical Center, Portland, OR; Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland, OR
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
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12
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Gerald A, McCandless M, Sheth A, Aihara H, Russo S. A Soft Sensor for Bleeding Detection in Colonoscopies. ADVANCED INTELLIGENT SYSTEMS (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 4:2100254. [PMID: 35757581 PMCID: PMC9216226 DOI: 10.1002/aisy.202100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 06/15/2023]
Abstract
Colonoscopies allow surgeons to detect common diseases i.e. colorectal cancer, ulcers and other ailments. However, there is a risk of bleeding in the lower gastrointestinal (GI) tract while maneuvering endoscopes. This may be due to perforations, hemorrhaging, polyps, diverticuli or post-biopsy complications. Thus, it is essential for the surgeon to be able to detect bleeding at the site and evaluate the severity of blood leakage. This paper presents a soft sensor that can detect the presence of blood at the bleeding site during colonoscopies. The sensor consists of optical waveguides that interface with a microfluidic channel. Blood flow causes absorption and scattering of incident light that can be picked up by the optical sensing apparatus via light transmission through the waveguide. The surgeon can be alerted when bleeding occurs through a graphical user interface. The device is compact and measures only 1 mm thick. This allows the sensor to be circumferentially mounted onto a colonoscope at different locations. The sensor is able to record the presence of blood as an optical loss, rapidly detect the presence of blood in under 100 milliseconds as it enters the microchannel, and differentiate between gastric fluid and blood through changes in measured optical loss.
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Affiliation(s)
- Arincheyan Gerald
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Max McCandless
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
| | - Avani Sheth
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
| | - Hiroyuki Aihara
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sheila Russo
- Department of Mechanical Engineering, Boston University, Boston, MA 02215, USA
- Materials Science & Engineering Division, Boston University, Boston, MA 02215, USA
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13
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Hsu WF, Chang CY, Chang CC, Chang LC, Chen CH, Lin CC, Lin YM, Lee CL, Wu HY, Lee HC, Lee YC, Su MY, Lin LJ, Chia SL, Wu MS, Chiu HM. Risk of colonoscopy-related complications in a fecal immunochemical test-based population colorectal cancer screening program. Endoscopy 2022; 54:290-298. [PMID: 33271603 DOI: 10.1055/a-1328-5126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive individuals than in the general population. The magnitude of the colonoscopy-related complication rate in FIT-positive individuals remains unknown. This study aimed to elucidate the colonoscopy-related complication rate after a positive FIT result and compare it with the rate when colonoscopy was performed for other purposes. METHODS Information regarding colonoscopy-related severe complications after a positive FIT result (FIT-colonoscopy) and ordinary colonoscopy during 2010-2014 was collected from the Taiwanese Colorectal Cancer Screening Program Database and National Health Insurance Research Database. Severe complications included significant bleeding, perforation, and cardiopulmonary events ≤ 14 days after colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications associated with FIT-colonoscopy compared with ordinary colonoscopy. RESULTS 319 114 FIT-colonoscopies (214 955 patients) were identified, 51 242 (16.1 %) of which included biopsy and 94 172 (29.5 %) included polypectomy. Overall, 2125 significant bleedings (6.7 ‰) and 277 perforations (0.9 ‰) occurred ≤ 14 days after FIT-colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications (adjusted odds ratio [aOR] 4.41, 95 % confidence interval [CI] 4.05-4.81); aOR 1.35, 95 %CI 1.12-1.53; aOR 1.88, 95 %CI 0.61-5.84, respectively). Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding (aOR 3.10, 95 %CI 2.90-3.32). CONCLUSIONS FIT-colonoscopy was associated with a more than two-fold risk of significant bleeding, especially when polypectomy was performed.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Yang Chang
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chun-Chao Chang
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Chun Chang
- College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hua Chen
- Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Changhua, Taiwan
| | - Chun-Che Lin
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Min Lin
- Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chia-Long Lee
- Department of Internal Medicine, Cathay General Hospital Medical Center, Taipei, Taiwan
| | - Hong-Yuan Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Chung Lee
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Surgery, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | - Yi-Chia Lee
- College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Yao Su
- Department of Medicine, Division of Gastroenterology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Li-Ju Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shu-Li Chia
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Ming-Shiang Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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14
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Lightdale JR, Walsh CM, Narula P, Utterson EC, Tavares M, Rosh JR, Riley MR, Oliva S, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Kramer RE, Ambartsumyan L, Otley AR, McCreath GA, Connan V, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S16-S29. [PMID: 34402485 DOI: 10.1097/mpg.0000000000003263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards). DISCUSSION The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.
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Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Pediatric Gastroenterology Department, Division of Pediatrics, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Division of Gastroenterology & Nutrition, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Department of Paediatrics, William Osler Health System, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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15
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Nielsen JC, Ploug M, Baatrup G, Kroijer R. Risk of post colonoscopy colorectal cancer following screening colonoscopy with low-risk or no adenomas: A population-based study. Colorectal Dis 2021; 23:2932-2936. [PMID: 34427981 DOI: 10.1111/codi.15886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
AIM In the Danish faecal occult blood test based bowel cancer screening programme, the first round was rolled out over 4 years. After roll-out, the planned faecal test recall procedure for individuals with either no or low risk adenomas at colonoscopy is 8 and 2 years, respectively. Here, we aimed to investigate the post colonoscopy colorectal cancer incidence in these two groups. METHODS All Danish screening individuals from 2014 to 2015 with a positive faecal test and either no or low risk adenomas at colonoscopy were included and followed for 3 years post screening for the event of colorectal cancer through national registries. RESULTS Out of 533,023 submitted faecal tests and 36,673 positive tests, 17,627 had no or low risk adenomas. We identified 60 (0.34%) individuals diagnosed with colorectal cancer within 3 years, 18 (0.29%) in the low risk adenoma group, and 42 (0.37%) in the no adenomas group (p = 0.44). Advancing age (HR = 1.079, p < 0.001) and higher faecal test value (HR = 1.001, p = 0.002) increased hazard of colorectal cancer occurrence, whereas male sex (HR = 1.3, p = 0.308) and having low risk adenomas (HR = 0.729, p = 0.264) did not. CONCLUSION We found no difference in post colonoscopy colorectal cancer occurrence between individuals with either no or low risk adenomas. Instead, advancing age and increased faecal test value was associated with a higher risk of post colonoscopy colorectal cancer.
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Affiliation(s)
| | - Magnus Ploug
- Surgical Department, Hospital South West Jutland, Esbjerg, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rasmus Kroijer
- Surgical Department, Hospital South West Jutland, Esbjerg, Denmark
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16
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Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
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17
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A Pragmatic Randomized Controlled Trial of an Endoscopist Audit and Feedback Report for Colonoscopy. Am J Gastroenterol 2021; 116:2042-2051. [PMID: 34515669 DOI: 10.14309/ajg.0000000000001498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Variation in endoscopist performance contributes to poor-quality colonoscopy. Audit and feedback (A/F) can be used to improve physician performance, particularly among lower performing physicians. In this large pragmatic randomized controlled trial, we compared A/F to improve endoscopists' colonoscopy performance to usual practice. METHODS Endoscopists practicing in Ontario, Canada, in 2014 were randomly assigned in October 2015 (index date) to receive (intervention group, n = 417) or not receive (control group, n = 416) an A/F report generated centrally using health administrative data. Colonoscopy performance was measured in both groups over two 12-month periods: prereport and postreport (relative to the index date). The primary outcome was polypectomy rate (PR). Secondary outcomes were cecal intubation rate, bowel preparation, and premature repeat after normal colonoscopy. A post hoc analysis used adenoma detection rate as the outcome. Outcomes were compared between groups for all endoscopists and for lower performing endoscopists using Poisson regression analyses under a difference-in-difference framework. RESULTS Among all endoscopists, PR did not significantly improve from prereport to postreport periods for those receiving the intervention (relative rate [RR], intervention vs control: 1.07 vs 1.05, P = 0.09). Among lower performing endoscopists, PR improved significantly (RR, intervention vs control 1.34 vs 1.11, P = 0.02) in the intervention group compared with controls. In this subgroup, adenoma detection rate also improved but not significantly (RR, intervention vs control 1.12 vs 1.04, P = 0.12). There was no significant improvement in secondary outcomes between the intervention and control groups. DISCUSSION A/F reports for colonoscopy improve performance in lower performing endoscopists (ClinicalTrials.gov: NCT02595775).
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18
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McCandless M, Gerald A, Carroll A, Aihara H, Russo S. A Soft Robotic Sleeve for Safer Colonoscopy Procedures. IEEE Robot Autom Lett 2021; 6:5292-5299. [PMID: 34027062 PMCID: PMC8132950 DOI: 10.1109/lra.2021.3073651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Colonoscopy is the gold standard for colorectal cancer diagnosis; however, limited instrument dexterity and no sensor feedback can hamper procedure safety and acceptance. We propose a soft robotic sleeve to provide sensor feedback and additional actuation capabilities to improve safety during navigation in colonoscopy. The robot can be mounted around current endoscopic instrumentation as a disposable "add-on", avoiding the need for dedicated or customized instruments and without disrupting current surgical workflow. We focus on design, finite element analysis, fabrication, and experimental characterization and validation of the soft robotic sleeve. The device integrates soft optical sensors to monitor contact interaction forces between the colon and the colonoscope and soft robotic actuators that can be automatically deployed if excessive force is detected, to guarantee pressure redistribution on a larger contact area of the colon. The system can be operated by a surgeon via a graphic user interface that displays contact force values and enables independent or coordinated pressurization of the soft actuators upon demand, in case deemed necessary to aid navigation or distend colon tissue.
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Affiliation(s)
- Max McCandless
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
| | - Arincheyan Gerald
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
| | - Ashlyn Carroll
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
| | - Hiroyuki Aihara
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Sheila Russo
- Mechanical Engineering Department, Boston University, Boston, MA 02215 USA
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19
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Opatowski M, Brun-Buisson C, Touat M, Salomon J, Guillemot D, Tuppin P, Watier L. Antibiotic prescriptions and risk factors for antimicrobial resistance in patients hospitalized with urinary tract infection: a matched case-control study using the French health insurance database (SNDS). BMC Infect Dis 2021; 21:571. [PMID: 34126937 PMCID: PMC8201676 DOI: 10.1186/s12879-021-06287-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Antibiotic resistance is increasing among urinary pathogens, resulting in worse clinical and economic outcomes. We analysed factors associated with antibiotic-resistant bacteria (ARB) in patients hospitalized for urinary tract infection, using the comprehensive French national claims database. METHODS Hospitalized urinary tract infections were identified from 2015 to 2017. Cases (due to ARB) were matched to controls (without ARB) according to year, age, sex, infection, and bacterium. Healthcare-associated (HCAI) and community-acquired (CAI) infections were analysed separately; logistic regressions were stratified by sex. RESULTS From 9460 cases identified, 6468 CAIs and 2855 HCAIs were matched with controls. Over a 12-months window, the risk increased when exposure occurred within the last 3 months. The following risk factors were identified: antibiotic exposure, with an OR reaching 3.6 [2.8-4.5] for men with CAI, mostly associated with broad-spectrum antibiotics; surgical procedure on urinary tract (OR 2.0 [1.5-2.6] for women with HCAI and 1.3 [1.1-1.6] for men with CAI); stay in intensive care unit > 7 days (OR 1.7 [1.2-2.6] for men with HCAI). Studied co-morbidities had no impact on ARB. CONCLUSIONS This study points out the critical window of 3 months for antibiotic exposure, confirms the impact of broad-spectrum antibiotic consumption on ARB, and supports the importance of prevention during urological procedures, and long intensive care unit stays.
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Affiliation(s)
- Marion Opatowski
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Christian Brun-Buisson
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Mehdi Touat
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Jérôme Salomon
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Didier Guillemot
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Philippe Tuppin
- French National Health Insurance (Cnam), 50 Avenue du Pr-André-Lemierre, 75986, Paris Cedex 20, France
| | - Laurence Watier
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France.
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France.
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20
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Wiggins B, Lamarche C, Gupta R, Deliwala S, Minaudo M. Splenic Injury After a Colonoscopy: Threading the Scope Carefully in Heritable Connective Tissue Disorders. Cureus 2021; 13:e15444. [PMID: 34113526 PMCID: PMC8184110 DOI: 10.7759/cureus.15444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Colonoscopies have reduced colorectal cancer (CRC) burden in the United States, and their utility has expanded to include various diagnostic and therapeutic indications. Complications are seen in up to 1% and increase with age and polypectomy. As colonoscopies become widespread, specific populations seem to be at a much higher risk; notably patients with heritable connective tissue disorders (HCTD). As life expectancy increases, these patients undergo routine screenings and require careful peri-endoscopic care to reduce adverse outcomes. Amongst HCTD, Ehlers-Danlos syndrome (EDS) is commonly implicated, however, no reports of Marfan syndrome (MS) exist. We present a unique case of splenic injury after colonoscopy in a patient with MS. Successful outcomes require early suspicion and emergent surgical evaluation in patients with hemodynamic instability after a colonoscopy. Increased ligament laxity and bowel fragility are the most likely mechanisms. Alternative CRC strategies like fecal immunochemical test (FIT), fecal occult, Cologuard, or virtual colonography can be considered.
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Affiliation(s)
- Brandon Wiggins
- Internal Medicine, Ascension Genesys Hospital, Grand Blanc, USA
| | - Cassandra Lamarche
- School of Medicine, Michigan State University College of Human Medicine, East Lansing, USA
| | - Rohit Gupta
- Internal Medicine/Pediatrics, Michigan State University, Flint, USA
| | - Smit Deliwala
- Internal Medicine, Michigan State University at Hurley Medical Center, Flint, USA
| | - Mark Minaudo
- Gastroenterology and Hepatology, Ascension Genesys Hospital, Grand Blanc, USA
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21
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Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:1978-1998. [PMID: 34003220 DOI: 10.1001/jama.2021.4417] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the US. OBJECTIVE To systematically review the effectiveness, test accuracy, and harms of screening for CRC to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2015, to December 4, 2019; surveillance through March 26, 2021. STUDY SELECTION English-language studies conducted in asymptomatic populations at general risk of CRC. DATA EXTRACTION AND SYNTHESIS Two reviewers independently appraised the articles and extracted relevant study data from fair- or good-quality studies. Random-effects meta-analyses were conducted. MAIN OUTCOMES AND MEASURES Colorectal cancer incidence and mortality, test accuracy in detecting cancers or adenomas, and serious adverse events. RESULTS The review included 33 studies (n = 10 776 276) on the effectiveness of screening, 59 (n = 3 491 045) on the test performance of screening tests, and 131 (n = 26 987 366) on the harms of screening. In randomized clinical trials (4 trials, n = 458 002), intention to screen with 1- or 2-time flexible sigmoidoscopy vs no screening was associated with a decrease in CRC-specific mortality (incidence rate ratio, 0.74 [95% CI, 0.68-0.80]). Annual or biennial guaiac fecal occult blood test (gFOBT) vs no screening (5 trials, n = 419 966) was associated with a reduction of CRC-specific mortality after 2 to 9 rounds of screening (relative risk at 19.5 years, 0.91 [95% CI, 0.84-0.98]; relative risk at 30 years, 0.78 [95% CI, 0.65-0.93]). In observational studies, receipt of screening colonoscopy (2 studies, n = 436 927) or fecal immunochemical test (FIT) (1 study, n = 5.4 million) vs no screening was associated with lower risk of CRC incidence or mortality. Nine studies (n = 6497) evaluated the test accuracy of screening computed tomography (CT) colonography, 4 of which also reported the test accuracy of colonoscopy; pooled sensitivity to detect adenomas 6 mm or larger was similar between CT colonography with bowel prep (0.86) and colonoscopy (0.89). In pooled values, commonly evaluated FITs (14 studies, n = 45 403) (sensitivity, 0.74; specificity, 0.94) and stool DNA with FIT (4 studies, n = 12 424) (sensitivity, 0.93; specificity, 0.85) performed better than high-sensitivity gFOBT (2 studies, n = 3503) (sensitivity, 0.50-0.75; specificity, 0.96-0.98) to detect cancers. Serious harms of screening colonoscopy included perforations (3.1/10 000 procedures) and major bleeding (14.6/10 000 procedures). CT colonography may have harms resulting from low-dose ionizing radiation. It is unclear if detection of extracolonic findings on CT colonography is a net benefit or harm. CONCLUSIONS AND RELEVANCE There are several options to screen for colorectal cancer, each with a different level of evidence demonstrating its ability to reduce cancer mortality, its ability to detect cancer or precursor lesions, and its risk of harms.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nora B Henrikson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Paula R Blasi
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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22
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Paszat LF, Sutradhar R, Luo J, Rabeneck L, Tinmouth J. Perforation and post-polypectomy bleeding complicating colonoscopy in a population-based screening program. Endosc Int Open 2021; 9:E637-E645. [PMID: 33880399 PMCID: PMC8050559 DOI: 10.1055/a-1381-7149] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background and study aims We aimed to estimate the rate of hospital admissions for perforation and for post-polypectomy bleeding, after outpatient colonoscopy following a first positive fecal occult blood test screen through the population-based ColonCancerCheck program in Ontario, Canada. Patients and methods We identified all individuals aged 50 to 74 years with a first positive CCC gFOBT screening result from 2008 to 2017 who underwent outpatient colonoscopy ≤ 6 months later and who did not receive a diagnosis of CRC ≤ 24 months later. We identified inpatient hospital admissions for colonic perforation ≤ 7 days after and for post-polypectomy bleeding ≤ 14 days following colonoscopy. Results Among 121,626 individuals who underwent colonoscopy, the rate of perforation was 0.6 per 1000 from 2008 to 2012 and 0.4 per 1000 from 2013 to 2017. The rate was elevated among those aged 70 to 74 years; those with comorbidities; when colonoscopy was performed by endoscopists other than gastroenterologists or endoscopists with low prior year volume; and when polypectomy was performed during colonoscopy. The rate of bleeding was 4.3 per 1000 and was elevated among those aged 70 to 74 years, those with comorbidity, and with complex polypectomy. Both outcomes were more common among those aged 70 to 74 years, those with a 5-year cumulative Charlson score ≥ 1, those with prior hospitalization for ischemic heart disease, and those with endoscopists whose prior year colonoscopy volume was in the three lower quartiles. Conclusions Colonic perforation and post-polypectomy bleeding, among participants of population-based colorectal screening programs who test positive in the absence of colorectal cancer, are infrequent but serious complications, which increase with participant age and comorbidity, and with endoscopist characteristics.
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Affiliation(s)
| | | | - Jin Luo
- Institute for Clinical Evaluative Sciences – Cancer Program, Toronto, Ontario, Canada
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23
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Herring E, Tremblay É, McFadden N, Kanaoka S, Beaulieu JF. Multitarget Stool mRNA Test for Detecting Colorectal Cancer Lesions Including Advanced Adenomas. Cancers (Basel) 2021; 13:cancers13061228. [PMID: 33799738 PMCID: PMC7998137 DOI: 10.3390/cancers13061228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Current approved non-invasive screening methods for colorectal cancer (CRC) include FIT and DNA-FIT testing, but their efficacy for detecting precancerous lesions that are susceptible to progressing to CRC such as advanced adenomas (AA) remains limited, thus requiring further options to improve the detection of CRC lesions at earlier stages. One of these is host mRNA stool testing. The aims of the present study were to identify specific stool mRNA targets that can predict AA and to investigate their stability under a clinical-like setting. A panel of mRNA targets was tested on stool samples obtained from 102 patients including 78 CRC stage I-III and 24 AA as well as 32 healthy controls. Area under the receiver operating characteristic (ROC) curves were calculated to establish sensitivities and specificities for individual and combined targets. Stability experiments were performed on freshly obtained specimens. Six of the tested targets were found to be specifically increased in the stools of patients with CRC and three in the stools of both AA and CRC patients. After optimization for the choice of the 5 best markers for AA and CRC, ROC curve analysis revealed overall sensitivities of 75% and 89% for AA and CRC, respectively, for a ≥95% specificity, and up to 75% and 95% for AA and CRC, respectively, when combined with the FIT score. Targets were found to be stable in the stools up to 3 days at room temperature. In conclusion, these studies show that the detection of host mRNA in the stools is a valid approach for the screening of colorectal cancerous lesions at all stages and is applicable to a clinical-like setup.
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Affiliation(s)
- Elizabeth Herring
- Laboratory of Intestinal Physiopathology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (E.H.); (É.T.)
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - Éric Tremblay
- Laboratory of Intestinal Physiopathology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (E.H.); (É.T.)
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - Nathalie McFadden
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
- Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Shigeru Kanaoka
- Department of Gastroenterology, Hamamatsu Medical Center, Naka-ku, Hamamatsu 432-8580, Japan;
| | - Jean-François Beaulieu
- Laboratory of Intestinal Physiopathology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada; (E.H.); (É.T.)
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
- Correspondence: ; Tel.: +1-819-821-8000
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24
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Yang SC, Wu CK, Tai WC, Liang CM, Li YC, Yeh WS, Lee CH, Yang YH, Tsai TH, Hsu CN, Chuah SK. Incidence and risk factors of colonoscopic post-polypectomy bleeding and perforation in patients with end-stage renal disease. J Gastroenterol Hepatol 2020; 35:1704-1711. [PMID: 31900958 DOI: 10.1111/jgh.14969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Colonoscopic polypectomy in end-stage renal disease (ESRD) patients are at risks of post-polypectomy bleeding and perforation, but evidences are limited. This study aimed to determine the incident polypectomy complications among ESRD patients. METHODS In the nationwide ESRD cohort, a propensity score matched case-control study design was conducted to assess risk associated with post-polypectomy bleeding and perforation using the Taiwanese National Health Insurance Research Database from 1997 to 2013 for adults aged 40 years and older; 7011 ESRD and 19 118 non-ESRD patients met the study criteria. A total of 5302 patients in each group were matched for further analyses. The primary endpoint was post-polypectomy bleeding or bowel perforation in 30 days. The secondary endpoint was mortality and length of hospital stay for the bleeding complications requiring hospitalization. RESULTS Overall incidences of post-polypectomy bleeding or perforation in patients with ESRD was higher than the non-ESRD group (5.83% vs 1.78%, P < 0.0001) in the matched cohort. High risk of adverse outcomes was associated with ESRD (adjusted odds ratio [aOR], 2.38, 95% confidence interval [CI], 1.85-3.05), female patient (aOR, 1.7, 95% CI, 1.37-2.11), history of acute myocardial infarction (aOR, 1.91, 95% CI, 1.1-3.32), liver disease (aOR, 1.79, 95% CI, 1.37-2.34), diabetes (aOR, 1.45, 95% CI, 1.16-1.82), cancer (aOR, 1.4, 95% CI, 1.09-1.81), inpatient setting (aOR, 13.19, 95% CI, 9.73-17.88), and prior use of clopidogrel (aOR, 1.61, 95% CI, 1.03-2.52) and warfarin (aOR, 2.03, 95% CI, 1.21-3.41). CONCLUSIONS End-stage renal disease was associated with approximately twofold higher risk of colonoscopic post-polypectomy bleeding or perforation and should be cautiously performed in this special population cohort.
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Affiliation(s)
- Shih-Cheng Yang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Cheng-Kun Wu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Chih-Ming Liang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Yu-Chi Li
- Division of Hepato-Gastroenterology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Wen-Shuo Yeh
- Division of Hepato-Gastroenterology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung, Taiwan
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25
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Forbes N, Boyne DJ, Mazurek MS, Hilsden RJ, Sutherland RL, Pader J, Ruan Y, Shaheen AA, Wong C, Lamidi M, Lorenzetti DL, Brenner DR, Heitman SJ. Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2020; 18:2192-2208.e12. [PMID: 32240836 DOI: 10.1016/j.cgh.2020.03.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In addition to monitoring adverse events (AEs) and post-colonoscopy colorectal cancers (PCCRC), indicators for assessing colonoscopy quality include adenoma detection rate (ADR) and cecal intubation rate (CIR). It is unclear whether there is an association between annual colonoscopy volume and ADR, CIR, AEs, or PCCRC. METHODS We searched publication databases through March 2019 for studies assessing the relationship between annual colonoscopy volume and outcomes, including ADR, CIR, AEs, or PCCRC. Pooled odds ratios (ORs) were calculated using DerSimonian and Laird random effects models. Sensitivity analyses were performed to assess for potential methodological or clinical factors associated with outcomes. RESULTS We performed a systematic review of 9235 initial citations, generating 27 retained studies comprising 11,276,244 colonoscopies. There was no association between procedural volume and ADR (OR, 1.00; 95% CI, 0.98-1.02 per additional 100 annual procedures). CIR improved with each additional 100 annual procedures (OR, 1.17; 95% CI, 1.08-1.28). There was a non-significant trend toward decreased overall AEs per additional 100 annual procedures (OR, 0.95; 95% CI, 0.90-1.00). There was considerable heterogeneity among most analyses. CONCLUSIONS In a systematic review and meta-analysis, we found higher annual colonoscopy volumes to correlate with higher CIR, but not with ADR or PCCRC. Trends toward fewer AEs were associated with higher annual colonoscopy volumes. There are few data available from endoscopists who perform fewer than 100 annual colonoscopies. Studies are needed on extremes in performance volumes to more clearly elucidate associations between colonoscopy volumes and outcomes.
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Affiliation(s)
- Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta
| | - Devon J Boyne
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - Matthew S Mazurek
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Robert J Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - R Liam Sutherland
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Abdel Aziz Shaheen
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Clarence Wong
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Mubasiru Lamidi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta.
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26
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Abstract
Splenic injury after colonoscopy is a rare (1:100 000) but serious complication after colonoscopy associated with high morbidity. Consequences range from a mild, self-limited splenic haematoma to the catastrophic shattered spleen and haemorrhagic shock. We present a case of a 68-year-old woman reporting to the emergency department with abdominal pain after colonoscopy. Abdominal CT with intravenous contrast showed a grade I splenic laceration with no active bleeding and a small amount of free fluid collected in the pelvis. General Surgery and Hospitalist Service recommended conservative measures. She was discharged 1 day later with normal haemodynamics and adequate pain control. In conclusion, patients with postcolonoscopy complications often seek evaluation in the emergency department; splenic injury must be considered in the differential. The significant morbidity and occasional mortality are reported from spleen injury after colonoscopy; therefore, the treating physician should promptly evaluate and treat this condition (with appropriate specialty consultation) to prevent untoward outcomes.
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27
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Incidence of and Risk Factors for Systemic Adverse Events After Screening or Primary Diagnostic Colonoscopy: A Nationwide Cohort Study. Am J Gastroenterol 2020; 115:537-547. [PMID: 32149780 DOI: 10.14309/ajg.0000000000000574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To estimate the systemic serious adverse event (SAE) rates after colonoscopy and to identify their risk factors. METHODS A nationwide cohort study was conducted using the comprehensive French claims databases SNDS (National Health Data System). Patients aged 30 years and over who underwent a first screening or diagnostic colonoscopy in 2010-2015 were included. The rates of cardiovascular and renal SAEs were estimated within 5 days after colonoscopy. The standardized incidence ratios were calculated to compare these incidence rates with those of the same events in the general population, and the associated risk factors were assessed by multilevel logistic regression. RESULTS Among the 4,088,799 included patients (median age, 59 years [interquartile range = 50-67]; 55.2% women; 30.1% with a Charlson index score ≤1), the 5-day SAE incidence rate was 2.8/10,000 procedures for shock, 0.87/10,000 for myocardial infarction, 1.9/10,000 for stroke, 2.9/10,000 for pulmonary embolism, 5.5/10,000 for acute renal failure, and 3.3/10,000 for urolithiasis. These SAEs occurred 3.3 to 15.8 times more often during the first 5 days after colonoscopy than expected in the general population. Thirty-day mortality rates ranged from 2.2/1,000 cases of urolithiasis to 268.1/1,000 cases of shock. Increasing age was associated with an increasing incidence of SAEs. Risks of shock and acute renal failure were associated with a greater number of comorbidities than the other SAEs. Colonoscopies in university hospitals were associated with higher risks, reflecting patient selection processes. DISCUSSION The systemic SAEs can be associated with a substantial mortality. They should be taken into account when deciding colonoscopy, in addition to perforation and bleeding, particularly in elderly patients with multiple comorbidities.
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28
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Ullah W, Rashid MU, Mehmood A, Zafar Y, Hussain I, Sarvepalli D, Hasan MK. Splenic injuries secondary to colonoscopy: Rare but serious complication. World J Gastrointest Surg 2020; 12:55-67. [PMID: 32128029 PMCID: PMC7044106 DOI: 10.4240/wjgs.v12.i2.55] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases. Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.
AIM To investigate the reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients
METHODS A structured search on four databases was done and 45 articles with 68 patients were selected. The reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients were identified and analyzed using SPSS.
RESULTS The mean age of the patients was 62.7 years with 64% females. Twenty two percent had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason for colonoscopy was screening (46%) followed by diagnostic colonoscopy (28%). Eighty seven percent of patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%), while minor spleen hematomas and lacerations were managed conservatively (38%). Six percent of the patients were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. The overall mortality was 10% while 77% had complete recovery. The reason of colonoscopy against presentation specifically, abdominal pain showed no statistical significance P = 0.69. The indication of colonoscopy had no significant impact on incidence of splenic injury (P = 0.89). Majority of the patients (47%) were managed with splenectomy while the rest were managed conservatively (P = 0.04). This association was moderately strong at a cramer’s V test (0.34). The Fisher exact test showed a higher mortality with spleen rupture (P = 0.028).
CONCLUSION Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality. The management of the patients can be individualized based on clinical presentation.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital, Abington, PA 19001, United States
| | - Mamoon Ur Rashid
- Department of Internal Medicine, Advent Health Hospital, Orlando, FL 32804, United States
| | - Asif Mehmood
- Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, United States
| | - Yousaf Zafar
- Department of Internal Medicine, UMKC, 5100 Rockhill Rd, Kansas City, MO 64110, United States
| | - Ishtiaq Hussain
- Department of Gastroenterology, Cleveland Clinic, Weston, FL 33331, United States
| | - Deepika Sarvepalli
- Department of Internal Medicine, Advent Health Hospital, Orlando, FL 32804, United States
| | - Muhammad Khalid Hasan
- Department of Gastroenterology, Advent Health Hospital, Orlando, FL 32804, United States
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29
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Tsapournas G, Hellström PM, Cao Y, Olsson LI. Diagnostic accuracy of a quantitative faecal immunochemical test vs. symptoms suspected for colorectal cancer in patients referred for colonoscopy. Scand J Gastroenterol 2020; 55:184-192. [PMID: 31906738 DOI: 10.1080/00365521.2019.1708965] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Determine diagnostic accuracy of a quantitative faecal immunochemical haemoglobin test (QuikRead go® FIT, Orion Diagnostica Oy) in symptomatic patients referred for colonoscopy, at various cut-offs and for one or two tests.Methods: Patients referred to four endoscopy units in mid-Sweden between 2013 and 2017 provided information on lower abdominal symptoms and faecal samples from two separate days prior to colonoscopy.Results: In all, 5.4% (13/242) patients had colorectal cancer (CRC). For one FIT at cut-off 10 µg Hb/g faeces, sensitivity for CRC was 92% (95% CI 78-100%) and specificity 77% (95% CI 72-83%); equal to 74%; 95% CI 68-80 (178/242) colonoscopies potentially avoidable and one CRC missed. Based on the maximal outcome of two FITs, sensitivity was 100%, specificity 71% (66-77%) and 68%; 95% CI 62-74 (160/237) colonoscopies potentially avoidable. Among 17% (42/242) patients with one FIT of >200 µg Hb/g faeces, 85% (11/13) had CRC. Positive predictive values of FIT varied 16.9-26.2% depending on cut-off and one or two FITs, whereas NPVs were 99% and above in all scenarios.In 60 patients reporting rectal bleeding, one FIT at cut-off 10 µg Hb/g discriminated well between CRC and other conditions (p = .001). In regression models, FIT was more important than age, sex and all symptoms.Conclusion: One or two FITs in symptomatic patients referred for colonoscopy imply powerful risk stratification abilities for CRC, even among patients reporting rectal bleeding. Larger studies in various settings will clarify how to make the best use of this opportunity. Trial registration: Clinicaltrails.gov NCT02491593.
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Affiliation(s)
| | - Per M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
| | - Louise I Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Camtö, Örebro University Hospital, Örebro, Sweden
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30
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Thavaraputta S, Laoveeravat P, Thavaraputta B, Rakvit A. Splenic rupture as a rare and unpredicted complication in a patient with systemic lupus erythematosus after colonoscopy. BMJ Case Rep 2019; 12:12/7/e229262. [PMID: 31302618 DOI: 10.1136/bcr-2019-229262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Colonoscopy is a common procedure that gastroenterologists perform on a daily basis. It is considered a low-risk outpatient procedure and patients can be discharged on the same day after the procedure. Colonoscopy has become more feasible with the increasing application of standard screening for colon cancer and diagnostic procedures for large intestinal disease. There are reported possible risk factors of splenic rupture during the procedure. However, splenic injury after colonoscopy is considered a rare complication and less than 100 cases have been reported in international literature. Interestingly, this is the first case report demonstrating systemic lupus erythematosus (SLE) as a possible risk factor leading to splenic rupture post-colonoscopy. Failure to recognise this possibility even in its rarity can lead to life-threatening complications. We present a case of an acute splenic rupture with massive intraperitoneal bleeding after colonoscopy in a patient with SLE.
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Affiliation(s)
- Subhanudh Thavaraputta
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Passisd Laoveeravat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Bhakhathorn Thavaraputta
- Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ariwan Rakvit
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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